Managing Depression Skillfullyhttp://blogs.psychcentral.com/managing-depression
A blog about learning to manage depression with skill by Michael Yapko, PhDFri, 31 Dec 2010 02:36:13 +0000en-UShourly1Fare Thee Well–Some Parting Thoughtshttp://blogs.psychcentral.com/managing-depression/2010/12/fare-thee-well-some-parting-thoughts/?pk_campaign=feed&pk_kwd=fare-thee-well-some-parting-thoughts
http://blogs.psychcentral.com/managing-depression/2010/12/fare-thee-well-some-parting-thoughts/?pk_campaign=feed&pk_kwd=fare-thee-well-some-parting-thoughts#commentsThu, 30 Dec 2010 16:00:51 +0000http://blogs.psychcentral.com/managing-depression/?p=241]]>When I first agreed to be a blogger for PsychCentral, it was an agreement to experiment with the blogging process. Now that I’ve blogged regularly for the three month trial period I’d committed to, I’ve discovered that blogging isn’t for me. I can offer the reasons, but the bottom line is that the relationship between blogger and reader is too distant to satisfy me.

I have not gotten very much in the way of feedback from readers. What feedback I have gotten has mostly been globally supportive (“nice piece”). A few replies were critical when someone disagreed with me. The most feedback I received was when I suggested that evidence from a variety of fields (epidemiology, neuroscience, genetics, epigenetics) all pointed to depression being far more a social problem than a medical one.

I have suggested that there can’t be a singular medical solution to what is largely (though not entirely) a social phenomenon.

When I wrote about the misinformation disseminated from the drug companies and their unconscionable overselling of antidepressants, some people got their dander up. They were adamant in their beliefs that “depression is a disease caused by a biochemical imbalance in the brain, the drugs are great, and any expert should already know that.”

The fact that the “shortage of serotonin hypothesis” has been all but disproven and that the drugs have been shown to be little more effective than placebos challenges peoples’ cherished beliefs, so I understand the negative reactions. But it points to a larger problem: Some people would apparently prefer to think of themselves as diseased rather than temporarily disempowered, lacking some key skills or perspectives that would help them improve.

In my blogs, I offered perspectives and things to do that have been shown to not only help people get better, but stay better. The evidence is clear that people in good relationships do better than those that are socially isolated. It takes a variety of skills to build such relationships, and these are not easily acquired in today’s increasingly impersonal world. Drugs alone can’t teach them. I’ve also talked about opportunities for prevention, something else you can’t do with drugs.

The rate of depression is rising in all age groups. Kids are the fastest growing group of depression sufferers. As we watch depression striking at younger and younger ages, all but assuring more lifelong struggles for more people, blaming genes or biochemistry isn’t going to solve the problem.

Unless we look at the human costs of the way we manage ourselves, the overemphasis on form over substance, the bullying of each other whether at school as kids or on the job as adults, the use of technology over face to face communication, and the many other things I’ve discussed in my posts, it is a sad prediction that the rates of depression will continue to rise. The World Health Organization has already predicted that to be the case, and despite my efforts to help stem the rising tide with information and perspective, the tide still rises.

Ultimately, it is about individual choices. Will the people who most need help be smart enough to ask for it? Will people take the good information available with just a few mouse clicks go the next step and put that information to good use? Will people stop listening to the commercials and the media loud-mouths and start to think for themselves?

Will people stop buying into the “I’m a victim” mindset and take charge of their lives?

I hope so. No one, but no one, recovers from depression by declaring themselves a victim or giving up the capacity to think critically. My work has been about helping people think, behave and live in more skillful and personally empowered ways.

As the New Year begins, I hope this will be the year where things take a turn for the better for all of us, but especially for you. May your New Year be a satisfying one. Thanks for reading my blogs.

Photo by “lowjumpingfrog,” available under a Creative Commons attribution, non-commercial license.

]]>http://blogs.psychcentral.com/managing-depression/2010/12/fare-thee-well-some-parting-thoughts/?pk_campaign=feed&pk_kwd=fare-thee-well-some-parting-thoughts/feed/10Anxiety in Childhood Often Precedes Depression in Adulthood- A Prevention Opportunity?http://blogs.psychcentral.com/managing-depression/2010/12/anxiety-in-childhood-often-precedes-depression-in-adulthood-a-prevention-opportunity/?pk_campaign=feed&pk_kwd=anxiety-in-childhood-often-precedes-depression-in-adulthood-a-prevention-opportunity
http://blogs.psychcentral.com/managing-depression/2010/12/anxiety-in-childhood-often-precedes-depression-in-adulthood-a-prevention-opportunity/?pk_campaign=feed&pk_kwd=anxiety-in-childhood-often-precedes-depression-in-adulthood-a-prevention-opportunity#commentsMon, 27 Dec 2010 15:23:06 +0000http://blogs.psychcentral.com/managing-depression/?p=234]]>A high level of anxiety in kids is a key early warning sign of emotional difficulties that can easily mushroom into eventually suffering anxiety and depression together. In fact, in the majority of adults, depression and anxiety co-exist, but they don’t have the same age of onset.

Typically, anxiety precedes depression by many years; the anxious child is much more likely to become an anxious and depressed, or “comorbid,” adult.

The most common form of anxiety, though not the only one, is social anxiety. When a child is fearful of other kids and avoids interacting with other kids (stays in the classroom at recess instead of going out and playing, for example), there is good reason to be concerned.

As children get older and the more they don’t fit in with other kids, the more they accumulate negative feedback from other kids; they are made fun of, they experience more rejection and their feelings get hurt, which further raises their anxiety about being around others. By the time they get older still, they become increasingly shy and quite likely lonely, as well. Shyness, loneliness, and depression are related.

All are associated with higher levels of anxiety, greater scanning for and detecting negative reactions in other people, and more internal focus (higher levels of rumination) on negative feelings. Shyness leads to more social avoidance, which then increases a sense of victimhood and depression.

Loneliness doesn’t just hurt emotionally, it hurts physically, too. Feeling lonely can make you more vulnerable to illness, and new research in the area of genetics suggests why. A recent study at UCLA revealed that people who described themselves as the loneliest on loneliness scales exhibited increased gene activity associated with inflammation and reduced gene activity for antibody production and antiviral responses. Chronic loneliness may actually change gene activity.

If your child is socially anxious, the psychological stress can affect him or her in both emotional and physical ways. To counter the social anxiety, the most important thing you can do is help him or her to develop coping and social skills. Every day this child doesn’t get along with others, he or she gets negative feedback that can cause bad feelings early in life, and lead those bad feelings to be an enduring way of life.

Learning how to begin and end friendly interactions, how to keep a nice conversation going, how to be easy to be around, how to “read” others, how to be smart about what to disclose and when, and many other such skills are best encouraged early on. Being trapped in a world with billions of other people with whom you don’t know how to interact skillfully assures a much more difficult life.

Helping a child to learn how to think about people, how to recognize their character strengths and talents, as well as their motivations and how to manage their manipulations, is most easily done by helping them learn about their own such patterns.

Talking with kids about important interactions they have with teachers and other students, encouraging the child to think through what was said and what the impact was or is likely to be is the kind of conversation that can start relatively early in life. Asking questions such as, “Why do you think the teacher said that to Billy?” and, “How do you think Billy was feeling when the teacher said that to him in front of the whole class?” or, “What would you have done if the teacher said that to you?” are questions that stimulate conversation and encourage the child to be observant, thoughtful, empathetic and deliberate.

Be especially careful not to make global statements about people, such as “The other kids act that way because they’re all jealous of you” or “They’re all spoiled rotten.” Global thinking discourages critical thinking.

Asking kids, “What if?” is a good technique for learning to manage anxiety. “What if something happened to me, what would you do? What if another kid did such-and-such, what do you think you would do?” Anxious children (and adults, too) tend to ask themselves “what if?” question regularly, which scares the heck out of them because they don’t have answers: What if I get lost and mom can’t find me? What if my parents divorce? What if my daddy dies?

The anxiety that comes from asking such frightening questions is normal. The key to learning to manage the anxiety and empower yourself in the process to trust your own judgment is to answer the question. It would be unpleasant to face the circumstances in the “what if?” question — unpleasant but manageable.

In dealing with your child, help him or her answer the question. Let the child learn to be a problem-solver instead of a worrier. Help your child learn to calm himself or herself with self-soothing techniques like slow, deep breathing, and relaxation or self-hypnosis techniques when facing stressful situations. These techniques will help better prepare your child for a lifetime of challenges.

]]>http://blogs.psychcentral.com/managing-depression/2010/12/anxiety-in-childhood-often-precedes-depression-in-adulthood-a-prevention-opportunity/?pk_campaign=feed&pk_kwd=anxiety-in-childhood-often-precedes-depression-in-adulthood-a-prevention-opportunity/feed/2Happy Holidays! Now Watch What You Say Because it Can’t Be Unsaidhttp://blogs.psychcentral.com/managing-depression/2010/12/happy-holidays-now-watch-what-you-say-because-it-cant-be-unsaid/?pk_campaign=feed&pk_kwd=happy-holidays-now-watch-what-you-say-because-it-cant-be-unsaid
http://blogs.psychcentral.com/managing-depression/2010/12/happy-holidays-now-watch-what-you-say-because-it-cant-be-unsaid/?pk_campaign=feed&pk_kwd=happy-holidays-now-watch-what-you-say-because-it-cant-be-unsaid#commentsWed, 22 Dec 2010 21:26:13 +0000http://blogs.psychcentral.com/managing-depression/?p=227]]>The largest group of depression sufferers in the United States is currently between ages 25 and 44. That will likely change as depression continues to strike at younger and younger ages.

One of the many characteristics of this age group that feeds their higher rates of depression is their belief that they should be able to say what they think and say what they feel “just because” — Just because they feel a particular way, they think it’s important to “put it out there.” There’s a common attitude that says, “Ya gotta keep it real.” Roughly translated, that means you have to speak the truth as you see it, telling people how you feel or what your reactions to them are in a given moment.

Never mind if others see it differently, never mind if your viewpoint is hurtful to others, never mind if being “real” sends out the wrong message, especially to more vulnerable children, that “this is the way it is.” There’s a significant sense of entitlement wrapped up in this behavior.

Watch a few trashy talk shows on television (if you can bear it). You’ll see people openly confess to outrageous and destructive behavior, you’ll see the mocking of the victims and the booing of the perpetrators, while the audience yells for more. It is terrible stuff to watch, but there’s a point: These people illustrate some of the worst of human behavior, and they strut proudly while doing so.

They offer their pathetic justifications and their thoughtless rationales and, frenzied studio audience aside, they seem to have no idea that the rest of the civilized world sees them as the worst possible examples of human beings.

There are people who grow up believing that people really do talk to each other in the style of trashy talk shows, confessing much too personal things on air, asking and answering very private, rude questions, and they don’t see anything wrong with it. They think you should be able to say whatever you want to whomever you want, regardless of how crass, tasteless, insulting, or mean-spirited it might be.

With no boundaries in place, their relationships limp along at the lowest level of quality.I raise this point for a reason: You have to decide what you’re willing to say to people, what you’re willing to disclose to them, and what you’re willing to let them say in your presence. You’re going to have to make decisions about where the boundaries will be established that define just how much “letting it all hang out” you’re willing to tolerate in yourself and others.

If you believe you should be able to say anything you want to others, especially the people closest to you, then you’ll end up saying things to people when you’re hurt, angry or depressed that have the potential to destroy the relationship. Your bad feelings will come and go, but that person will hear the echoes of those poisonous things you said for years to come.

There’s a skillful in-between that separates keeping your negative feelings “locked up inside” and simply blasting people with your frustration and despair. The in-between lies in developing enough impulse control to hold your tongue just long enough to decide whether to say something and, if you determine it’s important to, then how to say something for the best possible effect.

Impulse control means taking a pause, a deliberate and measured pause, before you say or respond to something in order to consider the implications and possible consequences of what you want to say.

What may be only a three-second pause according to the clock can be a very long time subjectively, long enough for you to consider your options and choose one deliberately based on what you think will be most helpful in the circumstances. Learning to pause before you reply prevents “snap” reactions that can make things worse by impulsively saying something hurtful to the person or by fanning the flames of anger and escalating conflict to an even higher level.

“Getting it off your chest” may initially feel good to you, but can lead you to feel even worse about yourself when later, after you cool off, you realize you were out of line. It would be nice to prevent having to apologize by handling it well at the time. Once you’ve said something thoughtless, it’s been said. Once the bell has been rung, you can’t un-ring it.

You might apologize, and your apology may even be graciously accepted, but the interaction will still be remembered as a negative that could have been prevented with some impulse control and forethought.

Depression adds an extra layer of complexity to this issue. When people are depressed, they typically feel tired, defeated, and barely able to cope. The idea of having to expend energy to watch what you say can seem like a huge effort and the apathy of depression leads people to think, or even say out loud, “who cares?” The hurt and anger towards others may lead one to ask, “who cares?”, but when the depression lifts and he’s ready to resume the relationship on a more positive basis, he discovers the relationship has been damaged, perhaps fatally.

It does take effort to watch what you say. It is extra work to have to consider other peoples’ feelings and analyze whether this is a situation best handled with no comment or by saying something purposeful. It takes extra thought to develop different options for saying something, then deciding which way to say it is likely to produce the better outcome for the circumstances.

But, this is how impulse control leads to the development of judgment, and how judgment evolves into a trust and higher regard for yourself. As you get better and better at controlling what you say until you know it’s worth saying, and as you get more skilled in saying things that “hit the mark” in your interactions, your self-esteem will grow. Good self-esteem evolves as you review important interactions with others and you get to say to yourself, “I like what I said and did there. I like the way I handled that.” When you’re able to say that to yourself most (not all) of the time, you’re doing well.

]]>http://blogs.psychcentral.com/managing-depression/2010/12/happy-holidays-now-watch-what-you-say-because-it-cant-be-unsaid/?pk_campaign=feed&pk_kwd=happy-holidays-now-watch-what-you-say-because-it-cant-be-unsaid/feed/0How Well Do You Know Yourself…Really?http://blogs.psychcentral.com/managing-depression/2010/12/how-well-do-you-know-yourself-really/?pk_campaign=feed&pk_kwd=how-well-do-you-know-yourself-really
http://blogs.psychcentral.com/managing-depression/2010/12/how-well-do-you-know-yourself-really/?pk_campaign=feed&pk_kwd=how-well-do-you-know-yourself-really#commentsSun, 19 Dec 2010 18:59:57 +0000http://blogs.psychcentral.com/managing-depression/?p=217]]>How well do you know yourself? Some of the most depressed people I’ve ever treated became depressed by trapping themselves in circumstances where they really just didn’t belong. With eyes wide open, yet not really seeing, they ignored their own basic nature and got absorbed in situations that violated that personal nature.

Here’s an example of what I mean. One of my clients, Joyce, is depressed, divorced, and in her mid-30s. A self-described “nester,” she claims she wants nothing more than to find the right man and settle down into a long and healthy marriage. But she has not been dating, socializing or putting herself in situations where she can meet eligible men who might be suitable to marry. Why not?

Because she has gotten herself into what I consider a bad situation with two different men who are her “friends.” Joyce calls these men “friends with privileges.” Even though they are “just friends,” with no illusion on anyone’s part that the relationship is going to turn romantic and possibly culminate in marriage, they are having sex together.

Joyce says, “It’s casual, there are no strings, it’s nice to be held, so what’s the harm?” Her level of self-deception is extremely high, keeping her depressed, feeling very bad about herself.

What is a “nester” doing in this kind of exploitative relationship? She wants marriage but is in a kind of relationship that saps her motivation to go out and meet new people. Although she claims to value depth and commitment, she engages in intimate behavior that is in direct violation of those values.

As a direct result of this “solution” to her lack of a love life, she pretty much hates herself, feels cheapened by it, yet feels stuck in it because of all the conflicting emotions involved. She is depressed because she is violating her self-awareness and sabotaging her own goals.

Knowing yourself is difficult. It requires that you think clearly about your desires and values and then you act in accordance with them. Making moral compromises, getting lost in the need for contact or approval, selling out for a raise or a promotion are pathways to unhappiness. You want to know yourself well enough to be able to stay out of situations that are attractive on one level, but violate your sense of yourself on another.

How can you assess how well someone else really knows himself? When he says, “I’m ready for a commitment,” that sounds good, but is it true? When someone says, “I can complete this for you by Friday,” should you believe her? The key point is this: Most often, but not always, people are telling you what they believe to be true about themselves.

Some people intentionally lie and know they’re lying, but for most people it’s not about lying. It’s about self-deception. It’s about wanting, even needing, to believe we’re better than we really are. Thus, no one is going to say to you, “I’m a superficial person who callously uses other people for whatever I can take from them, so will you sleep with me?”

It takes some time to determine how well someone you’re assessing knows himself because you have to talk a lot and listen to what this person says about his or her character, temperament, or nature. You don’t need to believe, nor do you need to disbelieve, what you hear. You simply note it.

Over time, you watch for how well the things people do fit with what they said they’d do. The more consistent they are, the better it speaks for their level of self-awareness. Even when they’re inconsistent, if they’re responsible about it, they’ll acknowledge and try to mend the inconsistency. If they’re not responsible, they’ll make lame excuses for it.

This is why you don’t want to rush into things with people. Until you ask a lot of questions, until you observe the relationship between what someone says and what he does, you just don’t know how much of what he tells you will be true. Until you see someone in a variety of situations and moods, you won’t really know whether he can be respectful when angry or sensitive when stressed. It’s your responsibility to know yourself accurately, including your own vulnerabilities, so you don’t get too easily swept up in other peoples’ bull*@#*.

Photo by Nathan Csonka Photography, available under a Creative Commons attribution, non-commercial license.

]]>http://blogs.psychcentral.com/managing-depression/2010/12/how-well-do-you-know-yourself-really/?pk_campaign=feed&pk_kwd=how-well-do-you-know-yourself-really/feed/4What Do You Notice in Other People?http://blogs.psychcentral.com/managing-depression/2010/12/what-do-you-notice-in-other-people/?pk_campaign=feed&pk_kwd=what-do-you-notice-in-other-people
http://blogs.psychcentral.com/managing-depression/2010/12/what-do-you-notice-in-other-people/?pk_campaign=feed&pk_kwd=what-do-you-notice-in-other-people#commentsWed, 15 Dec 2010 18:21:28 +0000http://blogs.psychcentral.com/managing-depression/?p=205]]>When you meet someone for the first time, what do you tend to notice about him or her? Pause and think about your response. Do you tend to notice his or her appearance – manner of dress, physical attractiveness (or lack thereof), the quality of eyes, hair, teeth, skin, body size and weight?

Do you tend to notice his or her demeanor – smile, eye contact, friendliness, interest in and willingness to engage with others, use of touch and personal space? Do you focus on his or her intelligence, verbal skills, ability to articulate ideas, speed of replies and grasp of complex ideas?

Do you focus on his or her emotional qualities – easy to laugh, gentle, supportive, seductive? I’m barely scratching the surface of all there is to “tune into” with another person, and listing all the things there are to observe and respond to would take volumes. (In fact, volumes have been written about what we notice and respond to, both consciously and unconsciously, in others.)

But some characteristics clearly matter more than others because they have a stronger influence on how other people perceive them and behave toward them. You need to know what you’re looking for, and how to understand what people are telling you “between the lines” of what they say, so that you have realistic reactions to them.

It may sound a little cold, a little clinical to you, but I want to encourage you to practice assessing virtually everyone you meet and engage with in some way, whether it’s someone you intend to date or marry, someone you’re paired with in a team-building exercise at work, or someone you’re thinking of hiring or partnering up with in a new business.

Any time you are going to be in a position of potentially being influenced by the actions of someone else, you need to have a better-than-average grasp of how this person does things in order to know how to position yourself with him or her. By “position yourself,” I mean to say that you have to define your relationship with this person in specific circumstances.

Is it a relationship of equals, or is this an unequal relationship because this person is your boss or your child? You, and only you, can decide things like how much information to share, how much responsibility to take for what happens, and all the other factors that determine how this relationship will function. If you’re not used to thinking your way through relationships because you just assume “everyone is pretty much alike” or, “most people have a conscience” or, “I’m no bargain so I should be grateful for anyone just noticing me,” then you can begin to understand why your relationships may suffer.

Sometimes, people have a negative first reaction to the notion of deliberately assessing others. They say, “C’mon, it’s just a conversation at a cocktail party,” or, “Hey, it’s just a temporary project we share at work,” or the ever popular, “But, I love him (her)!” They don’t want to assess people because it seems too detached, too calculating. They want the freedom to follow their heart and get involved in one way or another. But then they complain bitterly when the relationship (predictably) goes badly.

Some people think assessing others is unnecessary because they naively think that if they treat the other person well or fairly, they will be treated well or fairly in turn. They are nice people. Foolish, but nice.

The Golden Rule (“Do unto others as you would have them do unto you”) does not preclude your being insightful and wise about what you do unto others and, in turn, what you allow them to do unto you. If you make the mistake of believing other people are just like you, you will be blindsided when you find out the hard way they’re willing to say and do things you’re not.

Assessing others doesn’t mean being unfriendly or cold or detached. It means being observant, neutral (without prejudging), as you interact with them in friendly, polite, and inviting ways. It further means recognizing and considering the implications of what people say and do, and choosing your own responses and behaviors in relation to them accordingly.

Acquiring enough good information about a person helps you be deliberate in deciding just how vulnerable to be with him or her, how much of your heart and soul (and body) to share. It doesn’t mean being overly suspicious of people. It means being cautious about making yourself vulnerable until you have a good sense of to whom you’re making yourself vulnerable, someone who can both respect and protect that vulnerability.

]]>http://blogs.psychcentral.com/managing-depression/2010/12/what-do-you-notice-in-other-people/?pk_campaign=feed&pk_kwd=what-do-you-notice-in-other-people/feed/3Self-Aware? Or Lost in Space?http://blogs.psychcentral.com/managing-depression/2010/12/self-aware-or-lost-in-space/?pk_campaign=feed&pk_kwd=self-aware-or-lost-in-space
http://blogs.psychcentral.com/managing-depression/2010/12/self-aware-or-lost-in-space/?pk_campaign=feed&pk_kwd=self-aware-or-lost-in-space#commentsSun, 12 Dec 2010 17:06:20 +0000http://blogs.psychcentral.com/managing-depression/?p=197]]>The tendency of people in general, and depressed people in particular, to excessively use their own frames of reference in interpreting and reacting to life experiences is called an “internal orientation” by psychologists. The term internal orientation describes someone who reflexively uses his or her internal experience, such as feelings, beliefs, and judgments, as the sole or primary basis for forming reactions and generating behaviors.

When your focus, or orientation, is an internal one, it means much of the time, perhaps too much of the time, you are either entirely or primarily engaged with whatever is going on inside of you.

Because our attention is limited –there are more things going on at any given moment than we can possibly pay conscious attention to – by having our focus over here, it means our focus isn’t over there. In practical terms, this means that when I focus intensely on how I’m feeling, I’m not focusing very much on how you’re feeling. When I focus narrowly on how I see it, it may not occur to me to consider how someone else sees it.

Is it possible to focus too much on your feelings? The research strongly indicates the answer is yes. People can get so wrapped up in their feelings, especially their depressed ones, that they can disconnect from others and withdraw into their own unhappy worlds – becoming lost in space.

It is important to have a balance between being self-aware but not too heavily focused on oneself at the expense of engaging well with others. Logically, you would think that these are not “either –or” distinctions, that I can be aware of my feelings and sensitive to your feelings, too. And, while that’s true, too often it isn’t how many people respond.

Instead, they get wrapped up in their own feelings, focused on themselves and their depression, and they miss partially or completely what’s going on with others around them. They may even justify it by believing that because they’re miserable, they don’t need to be engaged with or responsive to others. Others can see this as insensitive, or worse, and it creates the vicious cycle of generating negative feedback, which leads to more withdrawal over and over again.

An internal orientation can become so pervasive that it leads directly to an inability to relate well to other people. It is difficult to have empathy or concern for others when what matters most to you is how bad you feel.

Besides setting up the vicious cycle just described, it can also lead to an “It’s either them or me” kind of competition. When people view the world in this “us or them” way, other people can seem like the enemy, the people who can harm you, either in word or deed. It takes a lot when you’re depressed to strive to see what’s right with other people. The typical reflex is to see what’s wrong, what makes the other person seem insensitive, lacking understanding, or even just plain stupid. By comparison, our suffering can seem noble, beyond other’s comprehension.

This “you’re either with me or against me” mindset fueled by an internal orientation is evident in “hot spots” all over the world. Even in our own political elections, we rarely see a respectful exchange of viewpoints about what might be best for the country. Instead, we engage in accusation, innuendo and character assassination.

There isn’t nearly enough of an external orientation that would lead people outside their own thinking to examine what might be as good as or even better about a position professed to be held by “them.” If it’s the position of “them,” it is, by definition, a bad one. It’s why people will support mediocre candidates in their own party rather than someone more qualified in another party. Party loyalty prevents thinking clearly or objectively.

So, what is the “us” and “them” in regards to depression? If I met you at a cocktail party and we began to casually discuss depression, how would you define your position on the subject? Would you use only your own experience as the reference point? Would you acknowledge that depression is different for different people and accept a variety of viewpoints and experiences quite different than your own? Would you try to learn anything from someone else’s experience or would you simply conclude, “they just don’t get it?”

In these blogs, I make a point of stating regularly that each viewpoint about depression has some merit, and each person’s experience is valid (though not necessarily effective). However, I also say how important it is to evaluate what any one person’s viewpoint allows him or her to do and what it also prevents him or her from doing.

Consider this point carefully: What does your view of your depression encourage in you – and does it help keep you stuck or is it what’s going to help you eventually overcome depression?

]]>http://blogs.psychcentral.com/managing-depression/2010/12/self-aware-or-lost-in-space/?pk_campaign=feed&pk_kwd=self-aware-or-lost-in-space/feed/0Better Relationships? Why Bother?http://blogs.psychcentral.com/managing-depression/2010/12/better-relationships-why-bother/?pk_campaign=feed&pk_kwd=better-relationships-why-bother
http://blogs.psychcentral.com/managing-depression/2010/12/better-relationships-why-bother/?pk_campaign=feed&pk_kwd=better-relationships-why-bother#commentsWed, 08 Dec 2010 13:16:44 +0000http://blogs.psychcentral.com/managing-depression/?p=188]]>In my posts, I regularly focus on the importance of good relationships with others as a core ingredient of feeling good. Why? Because many studies from a variety of fields have all shown that people who are connected to other people in positive relationships have significantly lower rates of depression than those people who are not.

People in happy marriages, for example, have a much lower risk of developing depression than people who are unhappily single. People who have a network of positive and supportive friends have much less chance of becoming depressed than those who have no such network.

Good relationships can provide us with the basic needs we all have for love, intimacy and support. When you’re depressed, though, it sometimes seems too huge a task to engage with other people. When you’re hurting, you want to be left alone, and for those who try to support you, they often end up getting less than your best. So, why bother to try?

Most people sense intuitively how important it is to have positive and healthy connections to other people. Yet good relationships don’t “just happen.” People who don’t fit in well with others for any number of reasons, often become accustomed to being socially isolated from others. They may erroneously believe that others will never accept them, will always reject them, will never find them even marginally worthwhile, and will always consider them essentially useless.

Or, they believe that about others – no one can understand my pain, no one is worth confiding in, no one can help. Such damaging beliefs make developing good relationships impossible, and so the social skills necessary to make positive contact with others and build satisfying relationships never have occasion to develop.

The general health and mood benefits of good relationships now duly noted, let’s get a little more personal. Why should you bother to try to build relationships with anyone? Why should you expend any effort in the direction of getting connected to other people, especially if other people have been a source of hurt and pain in your life?

If you’re depressed, socially isolated, feeling emotionally scarred by what’s happened in your relationships, afraid to trust anyone again, yet also long for friendships or a caring, loving relationship with someone, you are in a dilemma. It’s what psychologists call an “approach-avoidance” conflict. It’s when you want something (“approach”) yet are afraid of it (“avoidance”), and the usual consequence is behavioral paralysis, or “freezing,” i.e., doing nothing at all.

How you resolve this dilemma (or don’t), will determine what happens next. If you could filter the fear out of the dilemma, the “avoidance” part of the “approach-avoidance” conflict, what would be different for you? Would you be less afraid of or even less hostile towards others? Wouldn’t it make a huge difference to focus on what you want, the “approach” part of the equation?

In the realm of relationships, when people put their fear of hurt or rejection ahead of their desire to be connected, withdrawing for self-protection seems to make sense. But, it’s a formula for keeping things the same, not for changing or improving things. It’s how time passes, but not depression. It’s a mindset that keeps you afraid, believing something bad will happen to you that you won’t be able to handle. Caving in to the imagined future hurts instead of learning how to prevent or manage them keeps depression the only constant companion in your life.

No one wants to take the time to develop skills without good reason. Well, you have good reason: When people get out of themselves, connect to others in a way that directly says there’s something about “us” that’s more important than just “me,” they feel better, get better, and truly are better. When you care and are cared about, you’ll feel better. That, in a nutshell, is the answer to the question, “why bother?”

Photo by Linh Ngan, available under a Creative Commons attribution, non-commercial license.

]]>http://blogs.psychcentral.com/managing-depression/2010/12/better-relationships-why-bother/?pk_campaign=feed&pk_kwd=better-relationships-why-bother/feed/2Form Over Substancehttp://blogs.psychcentral.com/managing-depression/2010/12/form-over-substance/?pk_campaign=feed&pk_kwd=form-over-substance
http://blogs.psychcentral.com/managing-depression/2010/12/form-over-substance/?pk_campaign=feed&pk_kwd=form-over-substance#commentsSun, 05 Dec 2010 18:07:29 +0000http://blogs.psychcentral.com/managing-depression/?p=177]]>The emphasis in our culture, unfortunately, has increasingly become one of form over substance: too often image matters more than truth. People are so wrapped up in their solitary pursuits of personal interests and satisfaction that other people have merely become tools for achieving it.

Truth and integrity end up taking a back seat to winning. Here’s an example: Parents emphasize the importance of getting into the “right” college, which becomes their child’s goal. School systems across the country now report huge increases in academic cheating. This is form over substance: the child would rather get an “A” however he or she gets it than an honest “B” or “C” that won’t get him or her entry into the “right” school.

One of my colleagues who teaches at a local university gave a student an “A-“ in a class, and this student, who felt fully entitled to an “A,” became so hostile and vindictive that she filed complaints with the university about the instructor and made harassing phone calls to her at all hours of the day and night.

Many other colleagues who teach in universities have told me similar stories of students behaving in threatening, intimidating ways in order to get a better grade than they deserve. One who teaches at Yale University, characterized the shift this way: “Students used to come in feeling it was their responsibility to learn. Now, too many come in feeling it is your responsibility to teach.”

Too many people today have a strong sense of entitlement, which is a basis for simmering anger, poor relationships, and subsequent depression.

Psychologist and researcher Jean Twenge of San Diego State University has captured this trend empirically in her studies of the attitudes of young people about themselves in relationship to others. She documents a growing narcissism in her superb book, Generation Me: Why Today’s Young Americans Are More Confident, Assertive, Entitled – and More Miserable than Ever Before.

Young people expect the world to be as programmable as their ipods, Twenge suggests, and consequently many don’t develop tolerance for others’ views, empathy for their feelings or needs, or an ability to build and maintain genuine relationships with others that can withstand inevitable conflicts and growing spasms.

Form over substance; it’s how we choose our political leaders, it’s how we choose the products whose advertising we know best, it’s how we justify misguided efforts that help keep us painfully the same, it’s how we raise our expectations of others (and ourselves, too) ever unrealistically higher, it’s how we fool ourselves into thinking we can do things we really can’t, and it’s how we become vulnerable to depression when we’re disappointed the substance didn’t match the form.

Depression doesn’t arise in a social vacuum. It arises in response to world conditions, family conditions, marriage conditions, social conditions. It is essential for each person to get past the often misleading superficial image of how things seem (advanced by people who benefit from people buying into it) in order to get closer to how things really are.

If you really want to challenge yourself in the best of ways, explore well thought out opinions that challenge yours rather than those that simply reinforce what you already believe, especially when what you believe is working against you in some way. Only when you have many different viewpoints about some issue can you evolve a better sense of how to generate more realistic solutions to the challenges you face.

]]>http://blogs.psychcentral.com/managing-depression/2010/12/form-over-substance/?pk_campaign=feed&pk_kwd=form-over-substance/feed/3What You Focus on You Amplify: Clinical Hypnosis Enhances Treatmenthttp://blogs.psychcentral.com/managing-depression/2010/12/what-you-focus-on-you-amplify-clinical-hypnosis-enhances-treatment/?pk_campaign=feed&pk_kwd=what-you-focus-on-you-amplify-clinical-hypnosis-enhances-treatment
http://blogs.psychcentral.com/managing-depression/2010/12/what-you-focus-on-you-amplify-clinical-hypnosis-enhances-treatment/?pk_campaign=feed&pk_kwd=what-you-focus-on-you-amplify-clinical-hypnosis-enhances-treatment#commentsWed, 01 Dec 2010 17:30:58 +0000http://blogs.psychcentral.com/managing-depression/?p=164]]>This post is all about developing the kind of focus that can not only help you feel better, but be better. I have much more than a casual interest in the topic of how your focus influences your life experience: For more than three decades, I have focused on two primary domains of professional interest: Applying clinical hypnosis in short term psychotherapies, and treating depression strategically in individuals, couples and families.

I have written many times on depression already, but a blog on the merits of clinical hypnosis is long overdue.

The field of clinical hypnosis has undergone a quiet revolution from seemingly being little more than a party gimmick to an established and vital component of psychotherapy and behavioral medicine programs in the finest academic and clinical institutions you can name, including Harvard, Yale and Stanford.

Someone unfamiliar with clinical hypnosis might be surprised to discover that hypnosis has been subjected to a wide variety of empirical investigations, particularly clinical and neuroscientific ones, attempting to better understand how a clinician’s words can become the basis for seemingly remarkable shifts in the subjective experience of a focused client.

Hypnosis involves selective attention, a narrowing of focus and an increased absorption in suggested experiences. Contrary to popular mythology, people absorbed in the experience of hypnosis are fully aware of what’s going on and are fully in charge of themselves. But, they are deeply focused on listening to and absorbing the therapeutic ideas the clinician introduces, taking them in and using them at more profound levels than they otherwise might.

Hypnosis isn’t magic; Hypnosis simply amplifies what goes on in any good therapy when a skilled clinician introduces new possibilities to a client seeking positive changes. No treatment is successful with all people, of course, but the ability of hypnosis to enhance treatment results in most individuals is impressive.

It makes sense that it would, because what lies at the heart of peoples’ problems is the quality and direction of their focus: they focus on feelings when they’d do better to focus on rational thinking, they focus on explaining problems and finding blame rather than developing solutions, they focus on what can go wrong instead of what can go right, or they focus on the negative past when they’d do better to focus on building their positive future. Clinical hypnosis can help change both the quality and direction of your focus.

Hypnosis sessions are most effective when structured according to the unique profile of the client. This includes things like the client’s goals for the session, attentional capabilities, cognitive style, and personal interests.

Generally, hypnosis sessions are about 20-30 minutes in length, embedded within the larger therapy session. Hypnotic procedures typically involve directing the client to close his or her eyes, relax, focus intently on the clinician’s words, and actively engage in the internal process of adapting the ideas and perspectives the clinician offers into a meaningful approach to resolving or changing the specific problems or symptoms under consideration.

As a common example, a clinician might suggest to a client in hypnosis the idea that he or she be more deliberate about gathering objective information (“reality testing”) before jumping to an erroneous and self-damaging conclusion, an unfortunate but typical cognitive pattern often associated with depression. Of course, this is the same sensible idea a clinician might suggest without the benefit of hypnosis, but the client’s absorption of the message is considerably more rapid and intense when focused during hypnosis.

Anyone who practices clinical hypnosis does so with the firmly entrenched and therapeutically invaluable belief that people have many more abilities than they consciously realize. Hypnosis creates an amplified experience for people to explore, discover, and use more of their innate abilities. Hypnosis also makes it easier to learn new skills.

There are many ways to use hypnosis in treating depression including building positive expectations to counter hopelessness, reframing emotion-laden memories, enhancing perceptual flexibility, instilling better coping skills, and increasing self-efficacy. Hypnosis as a subject of serious study, both in clinical and neuroscientific domains, is already reaping great dividends, and as new applications emerge, hypnosis has great potential to help people in ways they may never have considered before.

One piece of advice: I’m obviously encouraging the use of hypnosis as an established means of helping people feel and be better. But, I am strongly advocating that you only seek hypnosis from a well trained clinician, someone with a formal academic degree who is state licensed to provide health care. If you want a local referral, a good place to start is by visiting the website of the American Society of Clinical Hypnosis at www.asch.net and clicking on the “Public” tab.

There you’ll find a referral list of professionals for you to interview as possible therapists to consult. You can also call your local medical or psychological associations and ask for experienced clinicians who can help.

Photo by tacit requiem, available under a Creative Commons attribution non-commercial license.

]]>http://blogs.psychcentral.com/managing-depression/2010/12/what-you-focus-on-you-amplify-clinical-hypnosis-enhances-treatment/?pk_campaign=feed&pk_kwd=what-you-focus-on-you-amplify-clinical-hypnosis-enhances-treatment/feed/3Can Too Much Reliance on Technology Become a Depressant?http://blogs.psychcentral.com/managing-depression/2010/11/can-too-much-reliance-on-technology-become-a-depressant/?pk_campaign=feed&pk_kwd=can-too-much-reliance-on-technology-become-a-depressant
http://blogs.psychcentral.com/managing-depression/2010/11/can-too-much-reliance-on-technology-become-a-depressant/?pk_campaign=feed&pk_kwd=can-too-much-reliance-on-technology-become-a-depressant#commentsSun, 28 Nov 2010 15:55:33 +0000http://blogs.psychcentral.com/managing-depression/?p=150]]>Life in the United States and around the world has grown incredibly complicated, driven by many different forces, of course, but none more significant than technology. Before the internet, the mass media (television, radio, newspapers, magazines) was how we got entertainment, news, inspirations, and first direct insights into how others lived, even if they were just characters in a TV show.

Parents worried their kids watched too much TV now have to add “too much time in front of the computer” to their list of worries for their kids. Today, our view into peoples’ lives is much more personal as people place content directly on the internet through sites such as YouTube, MySpace and Facebook. More than half of young people under 21 have already put personal content on the internet, and many thousands more do so each day. Today’s average 21 year old has already sent and received more than a quarter million e-mails and text messages. Young people meet and interact in ways nearly unrecognizable to their parents.

Adults, too, regularly use computers and e-mail. We want our computers to be ever faster, slimmer, and easier to carry. We want our cell phones to have service everywhere, take and send e-mail and pictures, and organize our days for us. We want data instantly, and our e-mails slightly faster than that. We not only want these things, we expect them. The howling you hear when an internet server “goes down” for even a short while is truly frightening.

We are collectively spending much more time alone with our gadgets, in front of screens doing things that typically only indirectly involve other people. Too many of us are working longer hours and therefore the time available to be with other people is less. In fact, in a study done at Stanford University, at least a quarter of the adult respondents who use the internet regularly report that it has reduced their time with friends and family and increased their feelings of social isolation. Similarly, in a study published recently in a pediatrics journal, the kids who spend the most time with gadgets tend to have the lowest grades, the greatest difficulty concentrating, and the highest reports of feelings of life dissatisfaction.

This past week, an important article on this same subject was published in the New York Times, now available online, called “Growing Up Digital, Wired for Distraction.” (Here’s the link: http://www.nytimes.com/2010/11/21/technology/21brain.html). Written by Matt Richtel, the article explores how growing up in front of screens of all shapes and sizes is changing brain functions, especially of young people. The news isn’t all bad, of course, but there are definite down sides to how technology is making it more difficult to develop and maintain focus and develop social skills.

Can our heavy reliance on technology contribute to the rising rates of depression? Is it significant that as societies westernize, their rates of depression increase? More importantly, how can we continue to rely on technology as we surely will but do so in ways that don’t make it harder for us to develop the capacity to enjoy life? Technology isn’t going to go away, of course, and no one is suggesting it can or should. But, it may make a big difference in people’s lives to make a point of limiting how much time they spend in front of a screen. That time could be used in other ways that enhance life, diversifying and adding ways of feeling good, whether it’s spending social time with others, getting out into nature, creating something meaningful, or doing something else that’s positive and good for the soul.

Photo by chmeredith, available under a Creative Commons attribution non-commercial license.